| 07/17-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
Adult |
$269.69 |
$277.54 |
$285.38 |
| 07/17-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
BCCTP |
$1,223.33 |
$1,258.76 |
$1,294.19 |
| 07/17-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
Child |
$87.20 |
$89.76 |
$92.32 |
| 07/17-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
LTC |
$9,186.28 |
$9,353.87 |
$9,521.46 |
| 07/17-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
LTC/Full-Dual |
$5,620.22 |
$5,712.13 |
$5,804.04 |
| 07/17-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
OBRA |
$- |
$- |
$- |
| 07/17-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
SPD |
$755.63 |
$776.89 |
$798.14 |
| 07/17-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
SPD/Full-Dual |
$157.39 |
$161.26 |
$165.12 |
| 07/17-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
Behavioral Health Treatment 0-6 |
$2,549.14 |
$2,609.19 |
$2,671.26 |
| 07/17-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
Behavioral Health Treatment 7-20 |
$1,902.15 |
$1,946.96 |
$1,993.27 |
| 01/18-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Orange |
Cal Optima |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Orange |
Cal Optima |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Orange |
Cal Optima |
Optional Expansion |
$419.50 |
$433.47 |
$448.08 |
| 07/17-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
Adult |
$301.28 |
$310.02 |
$318.76 |
| 07/17-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
BCCTP |
$1,266.18 |
$1,302.92 |
$1,339.65 |
| 07/17-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
Behavioral Health Treatment 0-6 |
$2,772.30 |
$2,837.60 |
$2,905.09 |
| 07/17-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
Behavioral Health Treatment 7-20 |
$1,951.78 |
$1,997.76 |
$2,045.28 |
| 07/17-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
Child |
$86.21 |
$88.76 |
$91.31 |
| 01/18-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
LTC |
$6,573.35 |
$6,691.51 |
$6,809.67 |
| 07/17-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
LTC/Full-Dual |
$5,427.05 |
$5,515.16 |
$5,603.27 |
| 07/17-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
OBRA |
$- |
$- |
$- |
| 07/17-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
Optional Expansion |
$373.79 |
$386.14 |
$399.07 |
| 07/17-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
SPD |
$833.44 |
$855.97 |
$878.51 |
| 07/17-06/18 |
2017-18 |
COHS |
San Luis Obispo |
CenCal Health |
SPD/Full-Dual |
$208.31 |
$213.06 |
$217.80 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
Adult |
$313.18 |
$322.29 |
$331.40 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
BCCTP |
$1,342.64 |
$1,381.64 |
$1,420.64 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
Behavioral Health Treatment 0-6 |
$2,486.02 |
$2,544.58 |
$2,605.10 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
Behavioral Health Treatment 7-20 |
$1,963.52 |
$2,009.77 |
$2,057.58 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
Child |
$111.58 |
$114.87 |
$118.17 |
| 01/18-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
LTC |
$10,511.97 |
$10,698.62 |
$10,885.27 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
LTC/Full-Dual |
$6,824.58 |
$6,935.37 |
$7,046.15 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
OBRA |
$- |
$- |
$- |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
Optional Expansion |
$414.25 |
$427.98 |
$442.34 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
SPD |
$979.15 |
$1,005.82 |
$1,032.49 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Barbara |
CenCal Health |
SPD/Full-Dual |
$226.58 |
$231.79 |
$237.01 |
| 07/17-06/18 |
2017-18 |
COHS |
Merced |
Central California Alliance |
Behavioral Health Treatment 0-6 |
$3,028.99 |
$3,100.35 |
$3,174.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Merced |
Central California Alliance |
Behavioral Health Treatment 7-20 |
$2,254.71 |
$2,307.83 |
$2,362.72 |
| 01/18-06/18 |
2017-18 |
COHS |
Merced |
Central California Alliance |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Merced |
Central California Alliance |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Merced |
Central California Alliance |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Merced |
Central California Alliance |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Monterey |
Central California Alliance |
Behavioral Health Treatment 0-6 |
$2,816.09 |
$2,882.43 |
$2,950.98 |
| 07/17-06/18 |
2017-18 |
COHS |
Monterey |
Central California Alliance |
Behavioral Health Treatment 7-20 |
$2,055.07 |
$2,103.49 |
$2,153.52 |
| 01/18-06/18 |
2017-18 |
COHS |
Monterey |
Central California Alliance |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Monterey |
Central California Alliance |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Monterey |
Central California Alliance |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Monterey |
Central California Alliance |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central California Alliance |
Behavioral Health Treatment 0-6 |
$2,870.84 |
$2,938.47 |
$3,008.35 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central California Alliance |
Behavioral Health Treatment 7-20 |
$1,994.14 |
$2,041.12 |
$2,089.66 |
| 01/18-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central California Alliance |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Santa Cruz |
Central California Alliance |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central California Alliance |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Santa Cruz |
Central California Alliance |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Merced |
Central Coast Alliance |
Adult |
$277.64 |
$285.83 |
$294.01 |
| 07/17-06/18 |
2017-18 |
COHS |
Merced |
Central Coast Alliance |
BCCTP |
$1,120.81 |
$1,153.47 |
$1,186.13 |
| 07/17-06/18 |
2017-18 |
COHS |
Merced |
Central Coast Alliance |
Child |
$80.93 |
$83.39 |
$85.85 |
| 07/17-06/18 |
2017-18 |
COHS |
Merced |
Central Coast Alliance |
LTC |
$9,022.89 |
$9,186.16 |
$9,349.42 |
| 07/17-06/18 |
2017-18 |
COHS |
Merced |
Central Coast Alliance |
LTC/Full-Dual |
$5,274.44 |
$5,360.87 |
$5,447.29 |
| 07/17-06/18 |
2017-18 |
COHS |
Merced |
Central Coast Alliance |
OBRA |
$- |
$- |
$- |
| 07/17-06/18 |
2017-18 |
COHS |
Merced |
Central Coast Alliance |
Optional Expansion |
$302.33 |
$312.39 |
$322.92 |
| 07/17-06/18 |
2017-18 |
COHS |
Merced |
Central Coast Alliance |
SPD |
$839.86 |
$863.44 |
$887.02 |
| 07/17-06/18 |
2017-18 |
COHS |
Merced |
Central Coast Alliance |
SPD/Full-Dual |
$166.97 |
$170.98 |
$174.99 |
| 07/17-06/18 |
2017-18 |
COHS |
Monterey |
Central Coast Alliance |
Adult |
$327.18 |
$336.81 |
$346.45 |
| 07/17-06/18 |
2017-18 |
COHS |
Monterey |
Central Coast Alliance |
BCCTP |
$1,145.04 |
$1,178.63 |
$1,212.23 |
| 07/17-06/18 |
2017-18 |
COHS |
Monterey |
Central Coast Alliance |
Child |
$81.14 |
$83.60 |
$86.06 |
| 07/17-06/18 |
2017-18 |
COHS |
Monterey |
Central Coast Alliance |
LTC |
$10,228.39 |
$10,415.99 |
$10,603.60 |
| 07/17-06/18 |
2017-18 |
COHS |
Monterey |
Central Coast Alliance |
LTC/Full-Dual |
$6,671.58 |
$6,779.38 |
$6,887.19 |
| 07/17-06/18 |
2017-18 |
COHS |
Monterey |
Central Coast Alliance |
OBRA |
$- |
$- |
$- |
| 07/17-06/18 |
2017-18 |
COHS |
Monterey |
Central Coast Alliance |
Optional Expansion |
$374.20 |
$386.60 |
$399.59 |
| 07/17-06/18 |
2017-18 |
COHS |
Monterey |
Central Coast Alliance |
SPD |
$990.20 |
$1,018.07 |
$1,045.95 |
| 07/17-06/18 |
2017-18 |
COHS |
Monterey |
Central Coast Alliance |
SPD/Full-Dual |
$204.46 |
$209.03 |
$213.61 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central Coast Alliance |
Adult |
$345.13 |
$355.25 |
$365.38 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central Coast Alliance |
BCCTP |
$794.96 |
$818.24 |
$841.53 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central Coast Alliance |
Child |
$83.53 |
$86.08 |
$88.63 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central Coast Alliance |
LTC |
$7,915.78 |
$8,071.75 |
$8,227.72 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central Coast Alliance |
LTC/Full-Dual |
$5,497.51 |
$5,587.62 |
$5,677.74 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central Coast Alliance |
OBRA |
$- |
$- |
$- |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central Coast Alliance |
Optional Expansion |
$349.78 |
$361.24 |
$373.23 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central Coast Alliance |
SPD |
$1,094.14 |
$1,124.28 |
$1,154.42 |
| 07/17-06/18 |
2017-18 |
COHS |
Santa Cruz |
Central Coast Alliance |
SPD/Full-Dual |
$203.60 |
$208.19 |
$212.79 |
| 07/17-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
Adult |
$344.64 |
$354.84 |
$365.04 |
| 07/17-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
BCCTP |
$1,123.40 |
$1,156.31 |
$1,189.22 |
| 07/17-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
Child |
$65.83 |
$67.86 |
$69.88 |
| 07/17-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
LTC |
$11,822.17 |
$12,028.57 |
$12,234.97 |
| 07/17-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
LTC/Full-Dual |
$6,213.83 |
$6,314.06 |
$6,414.30 |
| 07/17-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
OBRA |
$- |
$- |
$- |
| 07/17-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
Optional Expansion |
$381.10 |
$393.69 |
$406.88 |
| 07/17-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
SPD |
$939.52 |
$964.58 |
$989.64 |
| 07/17-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
SPD/Full-Dual |
$228.69 |
$233.53 |
$238.37 |
| 07/17-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
Behavioral Health Treatment 0-6 |
$2,542.63 |
$2,602.53 |
$2,664.42 |
| 07/17-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
Behavioral Health Treatment 7-20 |
$2,095.40 |
$2,144.76 |
$2,195.77 |
| 01/18-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Ventura |
Gold Coast |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Ventura |
Gold Coast |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Ventura |
Gold Coast |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
Adult |
$300.77 |
$309.58 |
$318.39 |
| 07/17-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
BCCTP |
$1,255.44 |
$1,292.17 |
$1,328.90 |
| 07/17-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
Child |
$88.20 |
$90.82 |
$93.44 |
| 07/17-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
LTC |
$11,759.86 |
$11,979.37 |
$12,198.88 |
| 07/17-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
LTC/Full-Dual |
$5,352.71 |
$5,440.42 |
$5,528.14 |
| 07/17-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
OBRA |
$- |
$- |
$- |
| 07/17-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
Optional Expansion |
$377.71 |
$390.25 |
$403.38 |
| 07/17-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
SPD |
$819.17 |
$842.90 |
$866.63 |
| 07/17-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
SPD/Full-Dual |
$160.11 |
$164.14 |
$168.17 |
| 07/17-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
Behavioral Health Treatment 0-6 |
$2,960.91 |
$3,030.66 |
$3,102.74 |
| 07/17-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
Behavioral Health Treatment 7-20 |
$2,161.21 |
$2,212.12 |
$2,264.74 |
| 01/18-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
San Mateo |
Health Plan of San Mateo |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
Adult |
$320.09 |
$329.26 |
$338.43 |
| 07/17-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
BCCTP |
$2,223.22 |
$2,287.51 |
$2,351.80 |
| 07/17-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
Child |
$131.36 |
$135.17 |
$138.97 |
| 07/17-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
LTC |
$8,957.51 |
$9,120.24 |
$9,282.96 |
| 07/17-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
LTC/Full-Dual |
$5,770.77 |
$5,866.21 |
$5,961.65 |
| 07/17-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
OBRA |
$- |
$- |
$- |
| 07/17-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
Optional Expansion |
$445.61 |
$460.32 |
$475.71 |
| 07/17-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
SPD |
$1,125.64 |
$1,156.34 |
$1,187.04 |
| 07/17-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
SPD/Full-Dual |
$224.49 |
$229.02 |
$233.55 |
| 07/17-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
Adult |
$287.17 |
$295.42 |
$303.66 |
| 07/17-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
BCCTP |
$1,328.53 |
$1,366.77 |
$1,405.00 |
| 07/17-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
Child |
$91.55 |
$94.22 |
$96.90 |
| 07/17-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
LTC |
$7,471.89 |
$7,598.17 |
$7,724.44 |
| 07/17-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
LTC/Full-Dual |
$5,522.04 |
$5,612.21 |
$5,702.38 |
| 07/17-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
OBRA |
$- |
$- |
$- |
| 07/17-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
Optional Expansion |
$430.51 |
$444.83 |
$459.82 |
| 07/17-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
SPD |
$924.35 |
$950.39 |
$976.44 |
| 07/17-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
SPD/Full-Dual |
$152.32 |
$155.93 |
$159.55 |
| 07/17-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
Adult |
$303.96 |
$312.66 |
$321.36 |
| 07/17-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
BCCTP |
$1,203.07 |
$1,237.84 |
$1,272.61 |
| 07/17-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
Child |
$134.94 |
$138.89 |
$142.83 |
| 07/17-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
LTC |
$3,928.68 |
$4,000.70 |
$4,072.72 |
| 07/17-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
LTC/Full-Dual |
$4,349.61 |
$4,421.95 |
$4,494.28 |
| 07/17-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
OBRA |
$578.93 |
$595.77 |
$612.61 |
| 07/17-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
Optional Expansion |
$520.50 |
$537.71 |
$555.72 |
| 07/17-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
SPD |
$913.44 |
$938.75 |
$964.07 |
| 07/17-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
SPD/Full-Dual |
$317.93 |
$325.03 |
$332.13 |
| 07/17-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
Adult |
$289.44 |
$297.79 |
$306.14 |
| 07/17-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
BCCTP |
$1,307.41 |
$1,345.17 |
$1,382.94 |
| 07/17-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
Child |
$114.14 |
$117.50 |
$120.85 |
| 07/17-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
LTC |
$6,651.15 |
$6,771.28 |
$6,891.42 |
| 07/17-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
LTC/Full-Dual |
$5,732.26 |
$5,827.53 |
$5,922.80 |
| 07/17-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
OBRA |
$180.24 |
$185.55 |
$190.85 |
| 07/17-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
Optional Expansion |
$418.43 |
$432.24 |
$446.69 |
| 07/17-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
SPD |
$1,018.78 |
$1,046.88 |
$1,074.98 |
| 07/17-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
SPD/Full-Dual |
$305.06 |
$311.84 |
$318.62 |
| 07/17-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
Adult |
$338.54 |
$348.25 |
$357.97 |
| 07/17-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
BCCTP |
$1,236.78 |
$1,272.32 |
$1,307.86 |
| 07/17-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
Child |
$84.81 |
$87.26 |
$89.72 |
| 07/17-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
LTC |
$6,374.42 |
$6,501.29 |
$6,628.16 |
| 07/17-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
LTC/Full-Dual |
$4,326.18 |
$4,398.45 |
$4,470.72 |
| 07/17-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
OBRA |
$- |
$- |
$- |
| 07/17-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
Optional Expansion |
$430.99 |
$445.18 |
$460.03 |
| 07/17-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
SPD |
$1,090.41 |
$1,120.67 |
$1,150.94 |
| 07/17-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
SPD/Full-Dual |
$207.78 |
$212.13 |
$216.49 |
| 07/17-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
Adult |
$284.88 |
$293.12 |
$301.37 |
| 07/17-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
BCCTP |
$1,063.86 |
$1,094.63 |
$1,125.40 |
| 07/17-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
Child |
$129.40 |
$133.18 |
$136.97 |
| 07/17-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
LTC |
$6,216.53 |
$6,329.85 |
$6,443.16 |
| 07/17-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
LTC/Full-Dual |
$5,586.67 |
$5,677.62 |
$5,768.57 |
| 07/17-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
OBRA |
$231.50 |
$238.30 |
$245.10 |
| 07/17-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
Optional Expansion |
$381.99 |
$394.59 |
$407.77 |
| 07/17-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
SPD |
$1,051.85 |
$1,080.25 |
$1,108.66 |
| 07/17-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
SPD/Full-Dual |
$310.17 |
$316.90 |
$323.62 |
| 07/17-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
Behavioral Health Treatment 0-6 |
$2,850.98 |
$2,918.14 |
$2,987.54 |
| 07/17-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
Behavioral Health Treatment 7-20 |
$2,224.90 |
$2,277.31 |
$2,331.48 |
| 01/18-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Marin |
Partnership Health Plan |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
Behavioral Health Treatment 0-6 |
$2,684.68 |
$2,747.92 |
$2,813.27 |
| 07/17-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
Behavioral Health Treatment 7-20 |
$2,019.82 |
$2,067.40 |
$2,116.57 |
| 01/18-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Mendocino |
Partnership Health Plan |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
Behavioral Health Treatment 0-6 |
$2,765.17 |
$2,830.31 |
$2,897.62 |
| 07/17-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
Behavioral Health Treatment 7-20 |
$2,057.72 |
$2,106.19 |
$2,156.28 |
| 01/18-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Napa |
Partnership Health Plan |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
Behavioral Health Treatment 0-6 |
$2,757.72 |
$2,822.68 |
$2,889.81 |
| 07/17-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
Behavioral Health Treatment 7-20 |
$2,234.96 |
$2,287.60 |
$2,342.01 |
| 01/18-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Solano |
Partnership Health Plan |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
Behavioral Health Treatment 0-6 |
$2,877.19 |
$2,944.97 |
$3,015.01 |
| 07/17-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
Behavioral Health Treatment 7-20 |
$2,267.34 |
$2,320.75 |
$2,375.94 |
| 01/18-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Sonoma |
Partnership Health Plan |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |
| 07/17-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
Behavioral Health Treatment 0-6 |
$2,881.31 |
$2,949.18 |
$3,019.32 |
| 07/17-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
Behavioral Health Treatment 7-20 |
$2,114.19 |
$2,163.99 |
$2,215.46 |
| 01/18-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
Hepatitis C 340B |
$3,938.43 |
$3,938.43 |
$4,222.96 |
| 07/17-12/17 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
Hepatitis C 340B |
$5,615.24 |
$5,615.24 |
$6,010.88 |
| 01/18-06/18 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
Hepatitis C Non-340B |
$3,036.66 |
$3,036.66 |
$3,241.91 |
| 07/17-12/17 |
2017-18 |
COHS |
Yolo |
Partnership Health Plan |
Hepatitis C Non-340B |
$4,406.73 |
$4,406.73 |
$4,561.08 |